Ineffective appropriate shocks in coronary artery spasm disease: when defibrillation is not enough
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A 50-year-old woman without relevant medical history or risk factors received a single-chamber Fortify Assura (St Jude Medical) implantable cardioverter defibrillator (ICD) after recovering from sudden cardiac death (SCD). No structural heart disease was documented and coronary angiogram performed showed normal coronary arteries. Submuscular left-sided ICD implantation with dual-coil electrode was performed without incidences, defibrillation test was not performed. ICD was programmed in VVI 40 bpm for bradycardia and two zones for tachycardia settings (170–200 bpm monitor and > 200 bpm with maximum energy shocks: 36J+40Jx5, RV to SVC&can, biphasic, tilt 65%/65%, 5.6 ms). The patient was discharged and some weeks later was readmitted after syncope. ICD was interrogated showing a ventricular fibrillation (VF) episode that is correctly detected and treated with appropriate ICD shocks. Stored intracardiac electrograms showed ineffective shocks at maximum energy (Fig. 1a). ICD...
KeywordsCoronary artery spasm Implantable cardioverter defibrillator Defibrillation
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Myerburg RJ, Kessler KM, Mallon SM, Cox MM, de Marchena E, Interian A Jr, Castellanos A. Life-threatening ventricular arrhythmias in patients with silent myocardial ischemia due to coronary artery spasm. N Engl J Med 1992;326:1451–1455.Google Scholar
- 3.Takagi Y, Yasuda S, Tsunoda R, Ogata Y, Seki A, Sumiyoshi T, et al. Japanese Coronary Spasm Association. Clinical characteristics and long-term prognosis of vasospastic angina patients who survived out-of-hospital cardiac arrest: multicenter registry study of the Japanese Coronary Spasm Association. Circ Arrhythm Electrophysiol. 2011;4:295–302.CrossRefPubMedGoogle Scholar
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